FACTOID # 24: Looking for table makers? Head to Mississippi, with an overwhlemingly large number of employees in furniture manufacturing.
 
 Home   Encyclopedia   Statistics   States A-Z   Flags   Maps   FAQ   About 
   
 
WHAT'S NEW
 

SEARCH ALL

FACTS & STATISTICS    Advanced view

Search encyclopedia, statistics and forums:

 

 

(* = Graphable)

 

 


Encyclopedia > Sleeping sickness
Sleeping sickness
Classification & external resources
Trypanosoma forms in a blood smear.
ICD-10 B56.
ICD-9 086.5
DiseasesDB 29277 13400
MedlinePlus 001362
eMedicine med/2140 

Sleeping sickness or African trypanosomiasis is a parasitic disease in people and animals, caused by protozoa of genus Trypanosoma and transmitted by the tsetse fly. The disease is endemic in certain regions of Sub-Saharan Africa, covering about 36 countries and 60 million people. It is estimated that 50,000 to 70,000 people are currently infected, the number having declined somewhat in recent years.[1] Three major epidemics have occurred in the past hundred years, one from 1896–1906 and the other two in 1920 and 1970. Image File history File links Trypanosoma_sp. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... A parasite is an organism that lives in or on the living tissue of a host organism at the expense of it. ... The term disease refers to an abnormal condition of an organism that impairs function. ... Wikisource has an original article from the 1911 Encyclopædia Britannica about: Protozoa Protozoa (in Greek proto = first and zoa = animals) are single-celled eukaryotes (organisms whose cells have nuclei) that commonly show characteristics usually associated with animals, most notably mobility and heterotrophy. ... Trypanosoma is a notable genus of trypanosomes, a monophyletic[1] group of unicellular parasitic protozoa. ... Binomial name Glossina morsitans The tsetse fly, Glossina morsitans, is a fly (order Diptera) that eats blood from animals, including humans. ... In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. ... A political map showing national divisions in relation to deonte Shepard Club Of America Free burgers for new members the ecological break (Sub-Saharan Africa in green) A geographical map of Africa, showing the ecological break that defines the sub-Saharan area Sub-Saharan Africa is the term used to... In epidemiology, an epidemic (from [[Latin language] epi- upon + demos people) is a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is expected, based on recent experience (the number of new cases in the population during...

Contents

Clinical features

Symptoms begin with fever, headaches, and joint pains. As the parasites enter through both the blood and lymph systems, lymph nodes often swell up to tremendous sizes. Winterbottom's sign, the telltale swollen lymph glands along the back of the neck may appear. If untreated, the disease slowly overcomes the defenses of the infected person, and symptoms spread to include anemia, endocrine, cardiac, and kidney diseases and disorders. The disease then enters a neurological phase when the parasite passes through the blood-brain barrier. The symptoms of the second phase give the disease its name; besides confusion and reduced coordination, the sleep cycle is disturbed with bouts of fatigue punctuated with manic periods progressing to daytime slumber and nighttime insomnia. Without treatment, the disease is fatal, with progressive mental deterioration leading to coma and death. Damage caused in the neurological phase can be irreversible. Lymph nodes are components of the lymphatic system. ... Lymphadenopathy is swelling of one or more lymph nodes. ... Winterbottoms sign - Swollen lymph nodes along back of neck in child with early trypanosomiasis Winterbottoms sign is seen in the early phase of African trypanosomiasis, a disease caused by the parasites Trypanosoma brucei rhodiense and Trypanosoma brucei gambiense which is more commonly known as African sleeping sickness. ... Anemia (AmE) or anaemia (BrE), from the Greek () meaning without blood, is a deficiency of red blood cells (RBCs) and/or hemoglobin. ... Neurology is a branch of medicine dealing with disorders of the central and peripheral nervous systems. ... Freeze-fracture morphology of the blood-brain barrier of a rat The blood-brain barrier (abbreviated BBB, not to be confused with the blood-cerebrospinal fluid barrier, a function of the choroid plexus) is a membrane that controls the passage of substances from the blood into the central nervous system. ... Look up Confusion in Wiktionary, the free dictionary Confusion can have the following meanings: Unclarity or puzzlement, e. ... The Circadian rhythm is a name given to the internal body clock that regulates the (roughly) 24 hour cycle of biological processes in animals and plants. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ... A young girl sleeping Sleep is the regular state of natural unconsciousness observed in all mammals, birds and fish. ... This article or section does not cite any references or sources. ...


In addition to the bite of the tsetse fly, the disease is contractible in the following ways:

  • Mother to child infection: the trypanosome can cross the placenta and infect the fetus, causing perinatal death.
  • Laboratories: accidental infections, for example, through the handling of blood of an infected person and organ transplantation, although this is uncommon.
  • Blood transfusion

History

The condition has been present in Africa since at least the 14th century, and probably for thousands of years before that. The causative agent and vector were not identified until 1902–1903 by Sir David Bruce, and the differentiation between protozoa was not made until 1910. The first effective treatment, Atoxyl, an arsenic based drug developed by Paul Ehrlich and Kiyoshi Shiga was introduced in 1910 but blindness was a serious side effect. Numerous drugs designed to treat the disease have been introduced since then. Sir David Bruce (Melbourne, May 29, 1855 - November 27, 1931) was an English pathologist and microbiologist who investigated the Malta-fever and trypanosomes, identifying the cause of sleeping sickness. ... Structural formula of Atoxyl molecules Atoxyl® () is the name of a medicine which was common in the first decades of the 20th century, based on an Arsenic compound. ... General Name, Symbol, Number arsenic, As, 33 Chemical series metalloids Group, Period, Block 15, 4, p Appearance metallic gray Standard atomic weight 74. ... Paul Ehrlich Paul Ehrlich in his workroom Paul Ehrlich (March 14, 1854 – August 20, 1915) was a German scientist who won the 1908 Nobel Prize in Physiology or Medicine. ... Kiyoshi Shiga(志賀潔, February 7, 1871 - January 25, 1951) was a Japanese physician and bacteriologist. ...


There have been three severe epidemics in Africa over the last century: one between 1896 and 1906, mostly in Uganda and the Congo Basin, one in 1920 in several African countries, and one that began in 1970 and is still in progress. The 1920 epidemic was arrested due to mobile teams systematically screening millions of people at risk. The disease had practically disappeared between 1960 and 1965. After that success, screening and effective surveillance were relaxed due to the withdrawal of colonial authorities, and the disease has reappeared in endemic form in several foci over the last thirty years. [2]


Geographic distribution and epidemiology

The disease is found in two forms, depending on the parasite, either Trypanosoma brucei gambiense or Trypanosoma brucei rhodesiense. T. b. gambiense is found in central and western Africa; it causes a chronic condition that can extend in a passive phase for months or years before symptoms emerge. T. b. rhodesiense, is the acute form of the disease but has a much more limited range. It is found in southern and eastern Africa; its infection emerges in a few weeks and is more virulent and faster developing. According to recent estimates, the disability adjusted life years (9 to 10 years) (DALYs) lost due to sleeping sickness are 2.0 million.[3] Recent estimates indicate that over 60 million people living in some 250 foci are at risk of contracting the disease, and there are about 300,000 new cases each year.[4] The disease has been recorded as occurring in 36 countries, all in sub-Saharan Africa. Subspecies T. b. ... Subspecies T. b. ... A world map showing the continent of Africa Africa is the worlds second-largest and second most-populous continent, after Asia. ... In medicine, a chronic disease is a disease that is long-lasting or recurrent. ... In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ...


Humans are the main reservoir for Trypanosoma brucei gambiense, but this species can also be found in pigs and other animals. Wild game animals and cattle are the main reservoir of T. b. rhodesiense.


Horse-flies (Tabanidae) and Stomoxydinae possibly could play a role by mechanical transmission (in special situations) not only of Nagana (the animal form of sleeping sickness) but also of the human disease form.[5] Genera as listed in ITIS: Subfamily Chrysopsinae: Merycomyia Chrysops Neochrysops Silvius Subfamily Pangoniinae: Apatolestes Asaphomyia Brennania Esenbeckia Pegasomyia Stonemyia Goniops Subfamily Tabaninae: Anacimas Bolbodimyia Catachlorops Chlorotabanus Diachlorus Dichelacera Holcopsis Lepiselaga Leucotabanus Microtabanus Stenotabanus Haematopota Agkistrocerus Atylotus Hamatabanus Hybomitra Poeciloderas Tabanus Whitneyomyia Not placed: Zophina Among the worlds largest flies... Nagana, also called Animal African Trypanosomiasis, is a disease of vertebrate animals. ...


Life cycle

Life cycle of the Trypanosoma brucei parasites. Source: CDC

The tsetse fly is large, brown and stealthy. The bite feels like a hot needle being stuck into the flesh. While taking blood from a mammalian host, an infected tsetse fly (genus Glossina) injects metacyclic trypomastigotes into skin tissue. The parasites enter the lymphatic system and pass into the bloodstream (1). Inside the host, they transform into bloodstream trypomastigotes (2), are carried to other sites throughout the body, reach other blood fluids (e.g., lymph, spinal fluid), and continue the replication by binary fission (3). The entire life cycle of African Trypanosomes is represented by extracellular stages. A tsetse fly becomes infected with bloodstream trypomastigotes when taking a blood meal on an infected mammalian host (4,5). In the fly's midgut, the parasites transform into procyclic trypomastigotes, multiply by binary fission (6), leave the midgut, and transform into epimastigotes (7). The epimastigotes reach the fly's salivary glands and continue multiplication by binary fission (8). The cycle in the fly takes approximately 3 weeks to progress. Image File history File links AfrTryp_LifeCycle. ... Image File history File links AfrTryp_LifeCycle. ... Binomial name Glossina morsitans The tsetse fly, Glossina morsitans, is a fly (order Diptera) that eats blood from animals, including humans. ... Binary fission Binary fission is the form of asexual reproduction in single-celled organisms by which one cell divides into two cells of the same size, used by most prokaryotes. ...


Laboratory diagnosis

Two areas from a blood smear from a patient with African trypanosomiasis. Thin blood smear stained with Giemsa. Typical trypomastigote stages (the only stages found in patients), with a posterior kinetoplast, a centrally located nucleus, an undulating membrane, and an anterior flagellum. The two Trypanosoma brucei species that cause human trypanosomiasis, T. b. gambiense and T. b. rhodesiense, are indistinguishable morphologically. The trypanosomes length range is 14 to 33 µm, Source: CDC
Two areas from a blood smear from a patient with African trypanosomiasis. Thin blood smear stained with Giemsa. Typical trypomastigote stages (the only stages found in patients), with a posterior kinetoplast, a centrally located nucleus, an undulating membrane, and an anterior flagellum. The two Trypanosoma brucei species that cause human trypanosomiasis, T. b. gambiense and T. b. rhodesiense, are indistinguishable morphologically. The trypanosomes length range is 14 to 33 µm, Source: CDC

The diagnosis rests upon demonstrating trypanosomes by microscopic examination of chancre fluid, lymph node aspirates, blood, bone marrow, or, in the late stages of infection, cerebrospinal fluid. A wet preparation should be examined for the motile trypanosomes, and in addition a smear should be fixed, stained with Giemsa (or Field), and examined. Concentration techniques can be used prior to microscopic examination. For blood samples, these include centrifugation followed by examination of the buffy coat; mini anion-exchange/centrifugation; and the Quantitative Buffy Coat (QBC) technique. For other samples such as spinal fluid, concentration techniques include centrifugation followed by examination of the sediment. Isolation of the parasite by inoculation of rats or mice is a sensitive method, but its use is limited to T. b. rhodesiense. Antibody detection has sensitivity and specificity that are too variable for clinical decisions. In addition, in infections with T. b. rhodesiense, seroconversion occurs after the onset of clinical symptoms and thus is of limited use. Image File history File links Afric_tryp_1a_DPDxi. ... Image File history File links Afric_tryp_1a_DPDxi. ... A complex of stains specific for the phosphate groups of DNA. Used in Giemsa banding (or G-banding) to stain chromosomes and often used to create a karyotype. ... Buffy coat is the fraction of a centrifugated blood sample that contains most of the white blood cells. ...


Three similar serological tests are available for detection of the parasite; the micro-CATT, wb-CATT, and wb-LATEX. The first uses dried blood while the other two use whole blood samples. A 2002 study found the wb-CATT to be the most efficient for diagnosis, while the wb-LATEX is a better exam for situations where greater sensitivity is required. PMID 12481210


Treatment

The current standard treatment for first stage disease is:

  • Intravenous pentamidine (for T.b. gambiense); or
  • Intravenous suramin (for T.b. rhodesiense)

The current standard treatment for second stage (late stage) disease is: Pentamidine isethionate is a drug primarily given for prevention and treatment of Pneumocystis carinii pneumonia (PCP), a type of pneumonia often seen in people with HIV infection. ... Suramin or Suramin sodium is a medicinal drug developed by Oskar Dressel in 1916. ...

Alternative first line therapies include: Melarsoprol (INN) is a medicinal drug used in the treatment of Human African trypanosomiasis. ...

  • Intravenous melarsoprol 0.6 mg/kg on day 1, 1.2 mg/kg iv melarsoprol on day 2, and 1.2 mg/kg/day iv melarsoprol combined with oral 7.5 mg/kg nifurtimox twice a day on days 3 to 10;[7] or
  • Intravenous eflornithine 50 mg/kd every six hours for 14 days.[8]

In areas with melarsoprol resistance or in patients who have relapsed after melarsoprol monotherapy, the treatment should be: Eflornithine (α-difluoromethylornithine or DFMO) is a drug manufactured by Aventis which has various uses. ...

  • melarsoprol and nifurtimox, or
  • eflornithine

The following traditional regimens should no longer be used:

  • (old "standard" 26-day melarsoprol therapy) Intravenous melarsoprol therapy (3 series of 3.6 mg/kg/day intravenously for 3 days, with 7-day breaks between the series) (this regimen is less convenient and patients are less likely to complete therapy)[9];
  • (incremental melarsoprol therapy) 10-day incremental-dose melarsoprol therapy (0.6 mg/kg iv on day 1, 1.2 mg/kg iv on day 2, and 1.8 mg/kg iv on days 3–10) (previously thought to reduce the risk of treatment-induced encephalopathy, but now known to be associated with an increased risk of relapse and a higher incidence of encephalopathy)[7][9];

According to a treatment study of Trypanosoma gambiense caused human African trypanosomiasis, use of eflornithine (DMFO) resulted in fewer adverse events than treatment with melaroprol. PMID 16080099


All patients should be followed up for two years with lumbar punctures every six months to look for relapse.


History of treatment for sleeping sickness

Suramin was introduced in 1920 to treat the first stage of the disease. By 1922, Suramin was generally combined with Tryparsamide (another pentavalent organo-arsenic drug) in the treatment of the second stage of the gambiense form. It was used during the grand epidemic in West and Central Africa in millions of people and was the mainstay of therapy until 1969.


Pentamidine, a highly effective drug for the first stage of the disease, has been used since 1939. During the fifties, it was widely used as a prophylactic agent in Western Africa, leading to a sharp decline in infection rates. At the time, it was thought that eradication of the disease was at hand. Pentamidine isethionate is a drug primarily given for prevention and treatment of Pneumocystis carinii pneumonia (PCP), a type of pneumonia often seen in people with HIV infection. ... This page is a candidate to be moved to Wiktionary. ...


The organo-arsenical melarsoprol (Arsobal) was developed in the 1940s, and is effective for patients with second stage sleeping sickness. However, 3 - 10% of those injected have reactive encephalopathy (convulsions, progressive coma, or psychotic reactions), and 10 - 70% die; it can cause brain damage in those that survive the encephalopathy. However, due to its effectiveness, melarsoprol is still used today. Resistance to melarsoprol is increasing, and combination therapy with nifurtimox is currently under research. Melarsoprol (INN) is a medicinal drug used in the treatment of Human African trypanosomiasis. ... Encephalopathy is a container term for various conditions affecting the brain. ... Brain damage or brain injury is the destruction or degeneration of brain cells. ... Melarsoprol (INN) is a medicinal drug used in the treatment of Human African trypanosomiasis. ...


Eflornithine (difluoromethylornithine or DFMO), the most modern treatment, was developed in the 1970s by Albert Sjoerdsmanot and underwent clinical trials in the 1980s. The drug was approved by the United States Food and Drug Administration in 1990, but Aventis, the company responsible for its manufacture, halted production in 1999. In 2001, however, Aventis, in association with Médecins Sans Frontières and the World Health Organization, signed a long-term agreement to manufacture and donate the drug. Eflornithine (α-difluoromethylornithine or DFMO) is a drug manufactured by Aventis which has various uses. ... FDA logo The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food, dietary supplements, drugs, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products, and cosmetics in the United States. ... Aventis was formed in 1999 when Rhône-Poulenc S.A. merged with Hoechst AG. The merged company was based in Strasbourg, France. ... 2001 (MMI) was a common year starting on Monday of the Gregorian calendar. ... Médecins Sans Frontières ( (help· info)) (English: Doctors Without Borders) is a secular humanitarian-aid non-governmental organisation best known for its projects in war-torn regions and developing countries facing endemic disease. ... The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. ...


The genome of the parasite has been decoded and several proteins have been identified as potential targets for drug treatment. The decoded DNA also revealed the reason why generating a vaccine for this disease has been so difficult. T. brucei has over 800 genes that manufacture proteins that the disease mixes and matches to evade immune system detection. (Berriman, et al., 2005)


An international research team working in the Democratic Republic of the Congo, New Sudan and Angola involving Immtech International and University of North Carolina at Chapel Hill have completed a Phase IIb clinical trial and commenced a Phase III trial in 2005 testing the efficacy of the first oral treatment for Sleeping Sickness, known at this point as "DB289". [10] [11] Southern Sudan is a region of Sudan. ... The University of North Carolina at Chapel Hill is a public, coeducational, research university located in Chapel Hill, North Carolina, United States. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ...


Recent findings indicate that the parasite is unable to survive in the bloodstream without its flagellum. This insight gives researchers a new angle with which to attack the parasite.[12] // A Flagellum (plural: flagella) is a long, slender projection from the cell body, composed of microtubules and surrounded by the plasma membrane. ...


Prevention and control

Prevention and control focus on, where it is possible, the eradication of the parasitic host, the tsetse fly. Two alternative strategies have been used in the attempts to reduce the African trypanosomiases. One tactic is primarily medical or veterinary and targets the disease directly using monitoring, prophylaxis, treatment, and surveillance to reduce the number of organisms which carry the disease. The second strategy is generally entomological and intends to disrupt the cycle of transmission by reducing the number of flies. For in depth information on prevention of the disease via tsetse fly control see Tsetse fly control Binomial name Glossina morsitans The tsetse fly, Glossina morsitans, is a fly (order Diptera) that eats blood from animals, including humans. ...


Instances of sleeping sickness are being reduced by the use of the sterile insect technique. El Salvador successfully demonstrated the sterile insect technique eliminating the malaria causing mosquito, from a region for a period of time. ...


Regular active surveillance, involving case detection and treatment, in addition to tsetse fly control, is the backbone of the strategy for control of sleeping sickness. Systematic screening of communities in identified foci is the best approach as case-by-case screening is not practically possible in highly endemic regions. Systematic screening may be in the form of mobile clinics or fixed screening centres where teams travel daily to the foci. The nature of gambiense disease is such that patients don't seek treatment early enough because the symptoms at that stage are not evident or serious enough to warrant seeking medical attention, considering the remoteness of some affected areas. Also, diagnosis of the disease is difficult and most health workers may not be able to detect it. Systematic screening allows early-stage disease to be detected and treated before the disease progresses, and removes the potential human reservoir.[13] Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ...


There is a single case report of sexual transmission of West African sleeping sickness.[14] This is not believed to be an important route of transmission. A case of sexually transmitted sleeping sickness was the focus of an episode of House. House, also known as House, M.D., is a critically-acclaimed American medical drama television series created by David Shore and executive produced by Shore and film director Bryan Singer. ...


The cover story of the August 25, 2006 issue of Cell journal describes an advance; Dr Lee Soo-hee, working at Johns Hopkins, has investigated the pathway by which the organism changes its outer layer, avoiding immunological capture, using an enzyme called elongase. Dr Lee has dubbed this process the "Elongase Pathway". August 25 is the 237th day of the year in the Gregorian calendar (238th in leap years), with 128 days remaining. ... For the Manfred Mann album, see 2006 (album). ... Cell is a bi-monthly peer-reviewed scientific journal which publishes novel research in any area of experimental biology that is significant outside its field. ... The Johns Hopkins University, founded in 1876, is a private institution of higher learning located in Baltimore, Maryland, United States. ...


See also

The Drugs for Neglected Diseases Initiative (DNDi) is a not-for-profit drug development organization focused on improving the health and quality of life of people suffering from neglected diseases. ... Sir David Bruce (Melbourne, May 29, 1855 - November 27, 1931) was an English pathologist and microbiologist who investigated the Malta-fever and trypanosomes, identifying the cause of sleeping sickness. ... Tropical diseases are infectious diseases that either occur uniquely in tropical and subtropical regions (which is rare) or, more commonly, are either more widespread in the tropics or more difficult to prevent or control. ... Genera Blastocrithidia Crithidia Endotrypanum Herpetomonas Leishmania Leptomonas Phytomonas Trypanosoma Wallaceina Trypanosomes are a group of kinetoplastid protozoa distinguished by having only a single flagellum. ... Chagas disease (also called American trypanosomiasis) is a human tropical parasitic disease which occurs in the Americas, particularly in South America. ...

References

  • Berriman M et al. (2005). "The genome of the African trypanosome Trypanosoma brucei". Science 309 (5733): 416–22. PMID 16020726. 
  • Barrett MP et al.. "The trypanosomiases". Lancet 362 (9394): 1469-80. PMID 14602444. 

Science is the journal of the American Association for the Advancement of Science (AAAS). ... The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ...

Numbered references

  1. ^ WHO Media centre (2006). "Fact sheet N°259: African trypanosomiasis or sleeping sickness".
  2. ^ WHO Media centre (2001). "Fact sheet N°259: African trypanosomiasis or sleeping sickness".
  3. ^ World Health Organization (Geneva) (2000). "World Health Report 2000: Health Systems Improving Performance".
  4. ^ WHO Expert Committee on Control and Surveillance of African trypanosomiasis (Geneva) (1998). "WHO Technical Report Series,No.881".
  5. ^ Cherenet T, Sani RA, Panandam JM, Nadzr S, Speybroeck N, van den Bossche P (2004). "Seasonal prevalence of bovine trypanosomosis in a tsetse-infested zone and a tsetse-free zone of the Amhara Region, north-west Ethiopia". The Onderstepoort journal of veterinary research 71 (4): 307–312. 
  6. ^ (2000) "Efficacy of new, concise schedule for melarsoprol in treatment of sleeping sickness caused by Trypanosoma brucei gambiense: a randomised trial". Lancet 355 (9213): 1419–25. PMID 10791526. 
  7. ^ a b Bisser S, N'Siesi F-X, Lejon V, et al. (2007). "{{{title}}}". J Infect Dis 195: 322–29. 
  8. ^ van Nieuwenhove S, Schechter PJ, Declercq J, et al. (1985). "Treatment of gambiense sleeping sickness in the Sudan with oral DFMO (DL-alfa-difluoromethyl ornithine) an inhibitor of ornithine decarboxylase: first field trial". Trans R Soc Trop Med Hyg 79 (5): 692–8. 
  9. ^ a b Pepin J, Mpia B (2006). "Randomized controlled trial of three regimens of melarsoprol in the treatment of Trypanosoma brucei gambiense trypanosomiasis". Trans R Soc Trop Med Hyg 100: 437–41. PMID 16483622. 
  10. ^ Williamson, David. "Compound might defeat African sleeping sickness, clinical trial beginning this month", University of North Carolina, August 25, 2005. 
  11. ^ Staff. "Clinical Trials Update", Genetic Engineering News, September 15, 2005, p. 5. 
  12. ^ African Sleeping Sickness Breakthrough. Retrieved on April 7, 2006.
  13. ^ Strategic Direction for African Trypanosomiasis Research. Special Programme for Research and Training in Tropical Diseases. Retrieved on 2006-03-01.
  14. ^ Rocha G, Martins A, Gama G, Brandão F, Atouguia J. "Possible cases of sexual and congenital transmission of sleeping sickness". Lancet 363: 247. PMID 14738812. 

April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... For the Manfred Mann album, see 2006 (album). ... For the Manfred Mann album, see 2006 (album). ... March 1 is the 60th day of the year in the Gregorian calendar (61st in leap years). ...

External links


  Results from FactBites:
 
Sleeping sickness - Wikipedia, the free encyclopedia (1864 words)
Sleeping sickness or African trypanosomiasis is a parasitic disease in people and in animals.
Instances of sleeping sickness are being reduced by the use of the Sterile Atomic Fly.
A case of sexually transmitted sleeping sickness was the focus of an episode of House.
Trypanosomiasis (1398 words)
Sleeping sickness was first described in the fourteenth century in what is now the country of Mali.
It was only at the beginning of this century that the extent of destruction caused by sleeping sickness was recognized, and that millions were affected by an epidemic that left half a million dead.
If the entire population exposed to sleeping sickness could be under medical surveillance, the number of cases detected would undoubtedly reach the order of 250,000 to 300,000.
  More results at FactBites »

 
 

COMMENTARY     


Share your thoughts, questions and commentary here
Your name
Your comments

Want to know more?
Search encyclopedia, statistics and forums:

 


Press Releases |  Feeds | Contact
The Wikipedia article included on this page is licensed under the GFDL.
Images may be subject to relevant owners' copyright.
All other elements are (c) copyright NationMaster.com 2003-5. All Rights Reserved.
Usage implies agreement with terms, 1022, m